INTRODUCTION:Waste produced in the course of health care activities carries a higher potential for infection and injury than

another type of waste. There for it is essential to have safe and reliable method for its handling. Inadequate inappropriate handling of health care waste may have serious public health consequences and significant impact on the environment. Appropriate management of health care waste in thus a crucial component of environmental health protection and it should become an integral feature of health care protection DEFINITION:According to bio medical waste rules 1998 of India ,bio medical waste means any waste which is generated during the diagnosis ,treatment or immuni!ation of human being or animals or in research activities pertaining there to or in the production or testing of biological CLASSIFICATION OF HEALTH CARE WASTE [W .H. O] INFECTIOUS WSATE ! waste suspected to contain pathogens E.g. laboratory cultures, waste from isolation wards, tissues, materials or equipment that have been in contact with infected patients "AT#O$O%ICA$ WASTE" human tissues or fluids e.g. #ody parts, blood and other body fluids, feature S#A&"S:-Instruments having sharp end or pointed end $.g. needle, infusion sets, scalpels, %nives, blades, bro%en glass "#A&'ACEUTICA$ WASTE:- Waste containing pharmaceuticals $.g. pharmaceutical that are e&pired or no longer needed items contaminated by or containing pharmaceuticals ', bottle, bo&es( %ENOTO(IC WASTE:- Waste contain substances with genoto&ic properties e.g. waste containing cystostatic drugs'often used in cancer therapy( ,genoto&ic chemicals

 C#E'ICA$ WASTE needed, solvents

! Waste containing chemicals. $.g. laboratory

reagents, film developer, disinfectant ant that are e&pired or no longer WASTE WITH CONTENT OF HEAVY METALS:- batteries ,bro%en thermometers, blood pressure gau!es "&ESU&I)E* CONTAINE&S:- )as cylinder, gas cartridges ,aerosol cans &A*IOACTI+E WASTE ! Waste contain radio active substances unused substance from radio therapy or laboratory research SOURSES OF HEALTH CRAE WASTE: )overnment hospital *rivate hospitals +ursing homes *hysician clinic or office ,entist office or clinic ,ispensaries *rimary health care centre -edical research and training establishments -ortuaries #lood ban% and collection centers Animal houses .laughter houses /aboratories'clinic, pathology, hematology, microbiology( 0esearch organi!ations 1accinating centers #io technology institutions HEALTH CARE WASTE GENERATION:In middle and low income countries health care waste generated is lower than high income countries. ,eveloping countries that have performed their own surveys of health carte waste find the following essentials for an average e.g.

distribution of health care wastes useful for preliminary planning of waste management 234 general health care waste which may be dealt with by normal domestic and urban waste management system 564 pathological and infectious waste 54 sharps waste 74 chemical and pharmaceutical waste /ess than 54 special waste such as radioactive or cytotonic waste ,pressuri!ed containers or bro%en thermometers and used batteries HEALTH HAZARDS OF HEALTH CARE WASTE:$&posure of ha!ardous health care waste can result in disease or injury due to one or more of following characteristic It contains infectious agents It contains to&ic or ha!ardous chemicals or pharmaceuticals It contains sharps It is genoto&ic It is radio active All individuals e&posed to such ha!ardous health care waste are potentially at ris%, including those who generate the waste or those either handle such waste or are e&posed to it as a consequence of careless management. The main groups at ris% are" -edical doctors, nurses, health care au&iliaries and hospitals maintains personal *atients in health care establishments 1isitors to health care establishments Wor%ers in support service allied to health care establishments such as laundries ,waste handling and transportation Wor%ers in waste hospital facilities such as land fills or incinerators including scavengers a. 8a!ardous from infectious waste and sharps"

*athogens in infectious waste may enter the human body through a puncture, abrasions, or cut in the s%in, through mucus membranes by inhalation or ingestion b. 8a!ardous from chemical and pharmaceutical waste" -any of the chemicals and pharmaceuticals used in health care managements are to&ic, genoto&ic, corrosive flammable, reactive, e&plosive or shoc%9sensitive. Although present in small quantity they may cause in to&ification, either by or acute or chronic e&posure and injuries including burns c. 8a!ardous from genoto&ic waste" The severity of the ha!ardous for the health care wor%ers responsible for handling or disposal of genoto&ic waste governed by combination of the substance to&icity itself and e&tent and duration of or treatment with particular drug or chemical. The main pathway of e&posure is inhalation of dust or aerosol through the s%in, ingestion of food accidentally contaminated with cytoto&ic drugs, chemicals or waste etc d. 8a!ardous from radio active waste" The type disease caused by radioactive waste determined by the type and e&tent of e&posure. It can range headache, di!!iness and vomiting to much more serious problem. #ecause it is genoto&ic, it may also affect genetic material e. *ublic sensitivity " Apart from health ha!ardous the general public is very sensitivity to visual impact of health care waste particular anatomic waste TERATMENT AND DISPOSAL TECHNIQUES FOR HEALTH CARE WASTE " Incineration used to be the method of choice for most ha!ardous health care wastes and is still widely used. 8owever recently developed alternative treatment method are becoming increasingly popular. The final choice of treatment should be made on the basis of factors, many of which depend on local conditions I. INCINERATION:-

Incineration is a high temperature dry o&idation process that reduces organic and combustible waste to incombustible matter and result in a very significant reduction waste volume and weight .the process is usually selected to treat waste that cannot be recycled ,reused or disposed off in a land fill site Incineration requires no pretreatment, provided that certain waste types are not included in the matter to be incinerated. Ch ! "#$!%&#%"& '( #h$ ) &#$ &*%# +,$ ('! %-"%-$! #%'- !$: /ow healing volume 9above :333% cal;%g for single chamber incinerators and above 7633%cal;%g for pryolytic double chamber incinerators <ontent of combustible matter above =3 4 <ontent of non combustible solid below 64 <ontent of non combustible fines below :34 -oisture content below 734

W &#$ .!'/*"#& -'# #' +$ %-"%-$! #$/ !$:*ressuri!ed gas containers /arge amount of reactive chemical waste .ilver salts and photographic or radiographic waste Waste with high mercury or cadmium content such as bro%en thermometers, used batteries, and lead lined wooden panels .ealed ampoules> or ampoules> containing heavy metals

T0.$ '( %-"%-$! #'!&" Three basic %inds of incinerators technology are of interest for treating health 9 care waste ,ouble 9chamber pyrolytic incinerators which may be especially designed to burn infectious health care waste .ingle chamber furnace with static great, which should be used only if pyrolytic incinerators are not affordable.

 0otary %ilns operating at high temperature, capable of causing decompositions of genoto&ic substances and heat resistant chemicals %%.CHEMICAL DISINFECTION:<hemicals are added to waste to %ill or incinerate the pathogens it contains, this treatment usually result in disinfection rather than sterili!ation. <hemical disinfection is most suitable for treating liquid waste such as blood, urine, and stool or hospitals sewage. 8owever solid waste including microbiological cultures, sharps etc may be also be disinfected chemically with certain limitation. %%%. WET AND DRY THERMAL HEAT:W$# #h$!1 , h$ #: - wet thermal treatment or steam disinfection is based on e&posure of shredded infectious waste to high temperature, high pressure steam and is similar to autoclave sterili!ation process. The process is inappropriate for the treatment of anatomical waste and animal carcasses and will not efficiently treat chemical and pharmaceutical waste S"!$) ($$/ #$"h-','g0:- screw feed technology is the basis of non 9burn, dry treatment disinfection process in which waste is shredded and heated in a rotary auger. The waste is reduced by 234 in volume and by :3 74 in weight. This process is suitable for treating infectious waste and sharps. #ut it should not be used to process pathological cytoto&ic or radioactive waste %2. MICROWAVE IRRADIATION -ost microorganisms are destroyed by the action of micro wave of a frequency of about :?63 -8! and wave length of 5: :?cm. the water contained within the waste is rapidly heated by the microwaves and the infectious components are destroyed by heat conduction. The efficiency of the microwave wave disinfection should be chec%ed routinely through bacteriological and virological test 2. LAND DISPOSAL M*-%"%. , /%&.'& , &%#$: - if a municipality or medical authority genuinely lac%s the means to treat waste before disposal, the use of a land fills has to regard as

an acceptable disposable route. There are two type of disposal they are open dumps and sanitary landfills. 8ealth care should not be deposited on or around open dumps. The ris% of either people or animals coming to contact with infectious pathogens is obvious .anitary landfills are designed to have at least four advantages over open dumps" geological isolation of waste from the environment ,appropriate engineering preparation before the site is ready to accept waste , staff personal on site to control operations and organi!ed deposit and daily coverage of waste VI. INERTIZATION:The process of @inerti!ation involves mi&ing waste with cement and other substance before disposal in order to minimi!e the ris% of to&ic substance contained in the waste migrating in to the surface water or ground water. A typical proportion of mi&ture is =64 pharmaceutical waste, 564cent line, 564cement and 64 water. A homogenous mass is formed and cubes or pellets are produced on site and then transported to suitable site The Anited +ations conference on the environment and development 'A+<$,( in 5BB: recommended the following measures" *revent and minimi!e the waste production 0euse and recycle the waste to the e&tent possible Treat waste by safe and environmentally sound method ,ispose off the final residue by landfill in contained and carefully designated site

MAIN ADVANTAGES AND DISADVANTAGES OF TREATMENT AND DISPOSAL OPTIONS:,isposal method Advantages ,isadvantages

0otary %ilns

Adequate for all infectious waste, more . chemical waste pharmaceutical waste

high investment and

and operating costs

*yrolytic incineration

very high disinfection efficiency and most pharmaceuticals and chemical waste

incomplete destruction relativelyhigh investment and operating costs significant emission of need for periodic

adequate for all infectious waste of cytoto&ins

.ingle incineration

chamber

good disinfecting efficiency volume land fills

drastic reduction of weight and atmosphere pollutions the residue may be disposed of in removal of slag and soot

Wet treatment

thermal

environmentally sound relatively low investment operating costs

shredders are subject to and frequent brea%downs and poor functioning operation inadequate anatomical ,pharmaceutical chemical and waste is not requires qualified technicians

-icro irradiation

wave

good disinfection efficiency under readily steam permeable operating condition drastic reduction in waste volume potential operation and maintenance problems high investment

$ncapsulation

simple, low 9cost and safe may also be applied to pharmaceuticals not recommended for non sharp infectious

.afe burying

low cost and safe relatively safe if access to site is restricted and where infiltration is limited

waste safe only if access to precaution are ta%en natural site is limited and certain

Inerti!ation

relatively ine&pensive no need of highly trained operators insufficiency destroying in thermally

,rum

and

bric%

drastic reduction of weight and resistant volume of waste very low investment destroys only BB4 of microorganism massive gas emission of blac% smo%e ,fly ash to&ic

incinerator

<hemical disinfection

highly efficient disinfection under good operating conditions uses comprehensive measure ha!ardous safely substances that require

COLOUR CODING AND TYPE OF CONTAINER FOR DISPOSAL OF 3IOMEDICAL WASTE:C','! "'/%-g 45Y$,,') 65R$/ T0.$ '( "'-# %-$! *lastic bag ,isinfected container;plastic bag 753,*$8Wh%#$ *lastic T! -&,*"$-# 953, ": puncture container *lastic bag bag; proof <at.?,C Autoclaving;microwaving;chemical treatmentD destruction shredding <at.6,B,53 disposal in secured land fill <at.7,=,C W &#$ " #$g'!0 <at 5,:,7,= Autoclaving;microwaving T!$ #1$-# &"h$/*,$ Incineration; deep burial '.%-%'& .$!

CATEGORIES

OF

3IO-MEDICAL

WASTE

IN

INDIA

;AS

PER

THE

ENVIRONMENTAL<FOREST GUIDELINES5

C #$g'!0 -' C #$g'!0 4 C #$g'!06

W &#$ " #$g'!0 H*1 - - #'1%" , ) &#$ 'human tissues, organs, body parts( Animal waste'animal tissues, organs ,body parts, carcasses, bleeding ,fluids, e&perimental animals used in research, waste generated by veteneriary hospitals colleges, discharges from the hospital(

C #$g'!07

M%"!'+%','g0

<+%'#$"h-','g0

) &#$

'waste

from

laboratory

cultures, stoc%s or specimens of micro organism, liver or attenuated vaccines ,human and animal cell culture used in research and infectious agents from research Dindustrial laboratories( W &#$ &h !.& 'needles, syringes scalpels, blades, glass etc, that C #$g'!09 C #$g'!0= C #$g'!0 > may cause puncture and cuts .this includes both used and unused sharps( D%&" !/$/ 1$/%"%-$& -/ "0#'#'C%" /!*g& 'waste comprising of outdated, contaminated and discarded medicines ( S',%/ ) &#$ ' item contaminated with blood Dfluids including cotton dressing C #$g'!0? C #$g'!0 @ C #$g'!0 A C #$g'!0 4B solid plaster casts, linen, beddings, other material contaminated with blood( S',%/ ) &#$ 'waste generated form disposable items other than the waste sharps such as tubing, catheters, intravenous sets etc.( L%D*%/ ) &#$[ ) &#$ g$-$! #$/ (!'1 , +'! #'! !0 -/ /%&%-($"#%-g "#%2%#%$& I-"%-$! #%'- &h [ash from incineration of bio medical waste( Ch$1%" , *&$/ %- .!'/*"#%'- '( +%','g%" ,E "h$1%" ,& *&$/ %/%&%-($"#%'- & %-&$"#%"%/$& $#"

SUMMARY:-

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